Transfusion-related acute lung injury: advances in understanding the role of proinflammatory mediators in its genesis

• Published in: Expert Review of Hematology Vol. 6; no. 3; pp. 265 - 276
• Main Authors: West, F Bernadette, Silliman, Christopher C
• Format: Journal Article Book Review
• Language: English
• Published: England Taylor & Francis 01.06.2013; Expert Reviews Ltd; Informa Healthcare
• Subjects: Acute Lung Injury - epidemiology; Acute Lung Injury - physiopathology; Acute Lung Injury - therapy; Acute respiratory distress syndrome; Animals; antibodies; Antibodies - immunology; Antibodies - metabolism; biologic response modifiers; Blood Transfusion; Extracorporeal Membrane Oxygenation; Health aspects; HLA Antigens - immunology; Humans; Inflammation Mediators - metabolism; neutrophils; Neutrophils - immunology; Neutrophils - metabolism; plasma; platelet concentrates; red blood cells; Time Factors
• ISSN: 1747-4086; 1747-4094
• DOI: 10.1586/ehm.13.31

Transfusion-related acute lung injury (TRALI) is the most common cause of serious morbidity and mortality due to hemotherapy. The pathogenesis is the result of two events: the first related to the recipient's clinical condition, predisposing to acute lung injury (ALI) through neutrophil or polymorphonuclear leukocyte sequestration, and the second being the infusion of antibodies or mediators that activate these adherent polymorphonuclear neutrophils, resulting in endothelial damage, capillary leak and ALI. TRALI is most prevalent in the critically ill, although many of these cases are termed ALI. Although mitigation strategies, such as the use of male-only plasma, have decreased the number of TRALI cases and deaths, TRALI still occurs. This review will detail the pathophysiology of TRALI, provide insight into newer areas of research and critically assess current practices to mitigate TRALI and improve transfusion safety.